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SAN ANTONIO — TUESDAY, September 25, 2012 (MedPage Today) — The rate of extreme obesity fell in recent years among preschool-age children from low-income families, researchers found.

Although the percentage of children who were extremely obese rose by about 4.6 percent per year from 1998 to 2003, that proportion declined by about 1.8 percent per year through 2010, according to Liping Pan, MD, MPH, of the CDC's division of nutrition, physical activity, and obesity in Atlanta.

The recent improvement was consistent across age, sex, and race/ethnicity subgroups, with the exception of American Indians and Alaskan Natives, Pan reported at the Obesity Society meeting here.

"Our findings may have important health implications because extreme obesity in early childhood is associated with increased prevalence of cardiovascular risk factors, and the risk of obesity often persists into adulthood," she said.

"Population-based strategies to support environmental and policy change and intervention efforts in early care and the education setting, as well as the community setting, may be important for further reducing the prevalence [of extreme obesity]," she added.

Previous studies using data from the National Health and Nutrition Examination Survey showed an increase in the prevalence of extreme obesity among U.S. children from the 1970s to the mid 2000s, but no studies had examined recent national trends since 2006, according to Pan.

To explore the issue, she and her colleagues examined data on children, ages 2 to 4, living in low-income families from the CDC's Pediatric Nutrition Surveillance System. The current analysis included information on 26.7 million children from 30 states and the District of Columbia who were included in the database from 1998 to 2010.

The children included in the 2010 cohort were slightly younger, more likely to be Hispanic, and less likely to be non-Hispanic white or black compared with those in the 1998 cohort.

Extreme obesity — - defined as 1.2 times the 95th percentile of BMI according to CDC growth charts from the year 2000 — also increased in the early part of the study period, rising from 1.75 percent in 1998 to 2.22 percent in 2003.

However, the rate then declined steadily to 2.07 percent in 2010.

The initial increase in extreme obesity was consistent across ages, sexes, and races and ethnicities, with the exception of Asians and Pacific Islanders, in whom the rate did not change.

The decrease in the rate in the latter part of the study period was also largely consistent across the various subgroups, with the exception of American Indians and Alaskan Natives, in whom it did not change.

Pan said that there were multiple possible explanations for the recent reduction in the extreme obesity rate, including state and local childhood obesity prevention efforts across the U.S. dealing with childhood feeding practices and physical activity.

In addition, the decline could be related to national recommendations for preventing childhood obesity — such as those from the Institute of Medicine — or possibly from obesity prevention initiatives implemented within Women, Infants, and Children programs. Those include promotion of the American Academy of Pediatrics infant feeding practice guidelines and nutrition and physical activity education programs.

Pan acknowledged that the study had some limitations, such as the inclusion of low-income children from 30 states and the District of Columbia only and the possibility that the results may have been affected by the cut-points used to exclude biologically implausible height and weight measurements from the analysis.

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